Use of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0–3R) with Canadian Infants and Young Children Prenatally Exposed to Substances

Abstract

The current study examined the mental health diagnostic profiles of infants and young children prenatally exposed to substances using the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0–3R) diagnostic system. Participants were 46 biological mother–infant dyads who were engaged in a clinical program for mothers with substance‐use problems and their young children (aged 10–41 months). Diagnostic information was reported for each of the five axes listed in the DC:0–3R diagnostic system based on file reviews. In addition, the children's socioemotional and adaptive behaviors were assessed using the Child Behavior Checklist, Infant–Toddler Social Emotional Assessment, the Social‐Emotional Scale, and the Adaptive Behavior Assessment System (2nd ed.). In this sample of young children with prenatal substance exposure, a broad range of socioemotional symptoms were evident, with almost one third of the children meeting criteria for at least one Axis I mental health diagnosis. In addition, the majority of dyads demonstrated features of a disordered relationship. Children in more problematic relationships demonstrated higher levels of socioemotional and adaptive functioning difficulties and were more likely to have an Axis I diagnosis than were children in adapted relationships. The importance of early intervention efforts aimed at infants with prenatal substance exposure and their biological mothers is highlighted, with a particular focus on enhancing the quality of the mother–child relationship.

Multimodal Assessment of the Mother–child Relationship in a Substance‐exposed Sample: Divergent Associations With the Emotional Availability Scales

“…The scale demonstrates predictive validity to behavioral domains such as socioemotional functioning (e.g., Aoki, Zeanah, Heller, & Bakshi, ; Thomas & Guskin, ) as well as concurrent validity with the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], ; ) (Thomas & Guskin, ). The PIR‐GAS has been used in both observational and retrospective file‐review studies (Boris, Zeanah, Larrieu, Scheeringa, & Heller, ; Motz et al., ; Öztop & Uslu, ). PIR‐GAS ratings for this study were based on clinical case notes by therapists regarding the last few (3–5) home visit sessions that occurred closest to the time of each observation.…”

“…Motz et al. () found a moderate association of the PIR‐GAS with the Emotional Attachment and Emotional Availability (EA2) Clinical Screener (now referred to as the EA2 Clinical Screener ) recently included in the fourth edition of the EAS (Biringen, ), supporting the validity of the PIR‐GAS in a substance‐exposed sample.…”

“…Observations of these mother – child dyads reveal a difficult interactional pattern in which the mother lacks sensitivity and has a difficult time adjusting her own behaviors and emotional needs to support the needs of her child, while the child struggles with limited regulatory capacities and requires extra support (Pajulo et al., ). These relational difficulties are exacerbated by the myriad of risk factors associated with a substance‐using lifestyle including, but not limited to, poverty, single‐parenthood, maternal history of neglect and abuse, and maternal mental health difficulties (e.g., Motz et al., ; Nair, Schuler, Black, Kettinger, & Harrington, ). The cumulative effect of these stressors places the dyad at increased risk for maladaptive interaction patterns, and the child at risk for neglect and abuse (e.g., Coyl, Roggman, & Newland, ; Pajulo et al., ; Suchman, Mayes, Conti, Slade, & Rounsaville, ).…”

Applying a Developmental Framework to the Self‐Regulatory Difficulties of Young Children with Prenatal Alcohol Exposure: A Review

“…There have been several other studies describing psychiatric disorders in young children with PAE or FASD. Motz and colleagues () assessed 46 infants/children with PAE using the revised Diagnostic Classification of Mental Health and Developmental Disorder of Infancy and Early Childhood and found that almost one‐third met criteria for an Axis I mental health diagnosis. Using DSM‐IV criteria, O'Connor and colleagues () found 87% of children ( N = 23) with FASD had a psychiatric disorder.…”

Mother–Child Interaction as a Cradle of Theory of Mind: The Role of Maternal Emotional Availability

“…The EA-Scales have been validated and show a significant positive relationship to both maternal (e.g., Biringen et al, 2000) and child attachment security (e.g., Ziv, Aviezer, Gini, Sagi, & Koren-Karie, 2000). Recent studies (Espinet et al, 2013;Motz et al, 2012) have demonstrated that the EA2 Clinical Screener is significantly related to clinician ratings of mother-child interaction quality on the Parent-Infant Ratings Global Assessment Scale (PIR-GAS; ZERO to THREE, 2005).…”